Radiation Therapy and the Immune System: A New Horizon in Cancer Treatment
Radiation therapy has long been a cornerstone in the treatment of localized cancers, particularly those that have not metastasized. This modality works by using high-energy radiation to damage the DNA of cancer cells, thereby inhibiting their ability to reproduce and spread. However, the scope of radiation therapy is evolving. When combined with other treatment modalities, such as chemotherapy and immunotherapy, radiation therapy can be an effective option even for patients with metastatic cancer. Dr. Benjamin Schrank, a radiation oncologist at MD Anderson, underscores that certain drugs can significantly enhance the effectiveness of radiation therapy. For instance, cisplatin is often used in conjunction with radiation to treat head and neck or gynecologic cancers, while 5-fluorouracil is commonly paired with radiation for gastrointestinal cancers. Similarly, temozolomide is used alongside radiation therapy to treat glioblastoma, a particularly aggressive form of brain cancer.
Recent research spearheaded by Dr. Schrank, set to be presented at the 2024 American Society for Radiation Oncology (ASTRO) annual meeting, indicates a promising new pathway for immunotherapy-driven cancer treatment. Radiation therapy can induce an immune response, making it a potential partner with other drugs designed to treat cancer. The synergy between chemotherapy and radiation therapy introduces DNA damage to cancer cells, rendering them weaker and amplifying the effects of both treatments. This dual approach can tip the scales in favor of eradicating cancer cells, especially in cases where the cancer cells exhibit unique characteristics such as DNA repair mutations. For example, glioblastoma patients who receive a combination of radiation therapy and temozolomide benefit from this very mechanism, leveraging their DNA repair mutations to improve treatment outcomes.
Beyond the mechanical aspects of combining therapies, studies have shown that radiation therapy itself can stimulate the immune system to better recognize and combat tumor cells. Dr. Wen Jiang, another researcher at MD Anderson, explains that radiation therapy can trigger immune signaling pathways that drive a systemic anti-tumor response. This phenomenon has been observed in various types of cancer, including lung cancer, where combining radiation therapy with immunotherapy has yielded promising results. Dr. Schrank’s recent research on a first-in-class antibody-drug conjugate (ADC) represents another innovative strategy. This ADC targets a protein known as CD47, which tumors use to evade the immune system following radiation. By activating immune cells to engulf cancer cells, this approach not only kills cancer cells but also trains the immune system to recognize and fight tumors even after the treatment is complete.
Meanwhile, UCLA Health researchers are also making significant strides in the field of radiation oncology. At the annual ASTRO meeting, UCLA investigators will present 23 abstracts covering various subspecialties, including survivorship, lung cancer/thoracic malignancies, and physics. Other areas of focus include sarcoma, gastrointestinal cancer, genitourinary cancer, gynecological cancer, pediatric cancer, and diversity, equity, and inclusion in healthcare. Dr. Michael Steinberg, professor and chair of radiation oncology at UCLA, is particularly proud of his team’s research, which he believes showcases their commitment to improving patient outcomes and shaping the future of cancer treatment. One noteworthy presentation is abstract 1071, led by Dr. Joanne Weidhaas, which identifies a genetic signature to predict patients’ responses to treatment. This signature focuses on microrna-related single nucleotide polymorphisms (misnps), which can disrupt microrna signaling involved in regulating gene expression.
The study led by Dr. Weidhaas involved 90 patients with rectal cancer and aims to personalize treatment selection, potentially allowing some patients to avoid unnecessary surgery. In a secondary analysis of a clinical trial, researchers found that patients treated with MRI guidance for prostate cancer experienced fewer long-term side effects and enjoyed a better quality of life compared to those treated with CT-guided radiation. These findings will be presented by Dr. Amar Kishan during a session focused on optimizing the therapeutic ratio in prostate cancer. Another innovative study, led by Dr. Ann Raldow, explores the use of a mobile app called mpros for symptom monitoring during radiation treatment. This app enables patients to report symptoms in real-time and automatically alerts their clinical team in case of severe or worsening symptoms.
The study involving the mpros app included 59 patients receiving radiation therapy alongside chemotherapy for various types of cancer. While there were no significant differences in physical or mental health outcomes between the group using the app and the control group, patients in the app group reported feeling more engaged in their care. They also found the app helpful in tracking symptoms, highlighting the potential of digital health tools to enhance patient engagement and symptom management. Dr. Raldow will present these findings in a session dedicated to new frontiers in patient-reported outcomes and survivorship. This focus on patient-centered care is crucial, as it emphasizes the importance of not only extending life but also improving the quality of life for cancer patients.
The advancements in radiation oncology being showcased by both MD Anderson and UCLA Health underscore a broader trend in cancer treatment: the move towards personalized and integrated care. By combining traditional modalities like radiation and chemotherapy with cutting-edge approaches such as immunotherapy and digital health tools, researchers are pushing the boundaries of what is possible in cancer treatment. The goal is not merely to kill cancer cells but to create a holistic treatment plan that considers the unique genetic and molecular profile of each patient. This approach aims to maximize the effectiveness of treatment while minimizing side effects, ultimately leading to better patient outcomes.
One of the most exciting aspects of this research is the potential for radiation therapy to work synergistically with the immune system. The ability of radiation to induce an immune response opens up new avenues for combination therapies that could be more effective than traditional treatments alone. For instance, the use of ADCs that target specific proteins like CD47 could revolutionize how we approach cancer treatment, offering a dual mechanism of action that both directly kills cancer cells and enhances the body’s natural immune response. This represents a significant shift in the paradigm of cancer treatment, moving from a solely destructive approach to one that also harnesses the body’s innate defenses.
Moreover, the research being conducted at institutions like MD Anderson and UCLA Health is not just theoretical; it has real-world implications for patients currently undergoing treatment. The findings from these studies are being translated into clinical practice, offering new hope for patients who may not have responded to traditional therapies. For example, the identification of genetic signatures that predict treatment response can help doctors tailor therapies to individual patients, potentially sparing them from the side effects of ineffective treatments. Similarly, the use of digital health tools like the mpros app can improve patient engagement and symptom management, leading to better overall care.
As we look to the future, the integration of radiation therapy with other treatment modalities and digital health tools will likely become increasingly common. The ongoing research and clinical trials will continue to refine these approaches, making them more effective and accessible to a broader range of patients. This holistic approach to cancer treatment, which combines cutting-edge science with patient-centered care, represents the future of oncology. It is an exciting time in the field, with the potential to significantly improve outcomes for cancer patients worldwide.
In conclusion, the advancements in radiation therapy and its integration with other treatment modalities and digital health tools represent a new horizon in cancer treatment. Researchers at institutions like MD Anderson and UCLA Health are at the forefront of this innovation, pushing the boundaries of what is possible in oncology. By combining traditional treatments with cutting-edge approaches, they are not only improving patient outcomes but also paving the way for a more personalized and holistic approach to cancer care. The future of cancer treatment lies in this integration, offering new hope and possibilities for patients around the world.
The journey towards these advancements has been long and challenging, but the progress made so far is a testament to the dedication and ingenuity of researchers and clinicians. As we continue to explore the potential of radiation therapy and its combination with other treatments, we move closer to a future where cancer can be effectively managed, if not cured. The research being conducted today will shape the treatments of tomorrow, offering new hope to patients and their families. It is an exciting time in the field of oncology, with the promise of better outcomes and improved quality of life for cancer patients worldwide.